Case

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Shell Technique for Horizontal and Vertical Maxillary Bone Augmentation in a Partially Edentulous Patient with Aggressive Periodontal Disease

Luca Cordaro

A 46-year-old woman was referred for treatment whose main complaints were mobility of her fixed partial dentures (right maxilla and left mandible) and periodontal bleeding during function. She also reported having taken systemic antibiotics to treat recurrent swelling in the area of the upper left molars. The patient had not seen a dentist for at least 2 years. She did not smoke and had no history of major systemic disease other than two minor orthopedic procedures some years back. The first-visit examination revealed poor plaque control, tooth mobility, periodontal disease, and a residual dentition widely associated with deep periodontal pockets.
Surgical SAC classification
Complex
Prosthodontic SAC classification
Advanced
Source
Treatment Guide 7
Purchase price
10 Academy Coins
CPD/CME
0.15 hours
Publication date: Oct 13, 2014 Last review date: Apr 10, 2021 Next review date: Apr 10, 2021

General information

Case Type Extended Space
Jaw Maxilla
Area Anterior|Posterior
# of Teeth 5
# of Implants 3
Type of Implants One-Piece
Attachment One-Piece
Bone Augmentation Horizontal|Staged|Vertical
Augmentation Materials Autogenous chips|Autogenous block(s)|Xenogenous
Guided Surgery No
Soft Tissue Grafting None
Abutment Type Standard
Prosthesis Type FDP

Esthetic Risk Assessment

Esthetic Risk Factors Low Medium High
Medical Status Healthy Compromised
Smoking Habit Non-smoker Light smoker (< 10 cigarettes per day) Heavy smoker (≥ 10 cigarettes per day)
Patient's Esthetic Expectations Low Medium High
Lip Line No exposure of papillae Exposure of papillae Full exposure of mucosa margin
Periodontal Phenotype Low-scalloped, thick Medium-scalloped, medium-thick High-scalloped, thin
Shape of Tooth Crowns Rectangular Triangular
Infection at Implant Site None Chronic Acute
Bone Level at Adjacent Teeth ≤ 5 mm to contact point 5.5 to 6.5 mm to contact point > 7 mm to contact point
Prosthodontic Status of Neighboring Teeth Virgin Restored
Width of Edentulous Span 1 tooth (≥ 7 mm) 1 tooth (< 7 mm) 2 teeth or more
Soft Tissue Anatomy Intact Defective
Bone Volume Horizontally and vertically sufficient Horizontally deficient Deficient vertically or deficient vertically AND horizontally
  • * General SAC assessment modifiers that are also part of the ERA. To avoid redundancy they are listed in this section even if no complete ERA has been made.

  • ** Not applicable to the ERA of immediate placement cases and replaced by "Socket Integrity" listed below under "Surgical SAC Classification". For all other placement types this value is a classification determinant and listed here even if no complete ERA has been made.

Surgical SAC classification

SAC Level Complex
Defining Characteristics More than three missing teeth to be replaced with an implant-borne prosthesis or prostheses
Modality -
Placement Protocol Early or late implant placement
Tooth Site -
Socket Morphology -
Socket Integrity -
Bone Volume Deficient vertically or deficient vertically AND horizontally
Anatomic Risk High
Esthetic Risk Medium
Complexity High
Risk of Complications High

Prosthodontic SAC classification

SAC Level Advanced
Defining Characteristics Up to three missing teeth to be replaced with an implant-borne restoration or restorations
Loading Protocol Conventional or early
Retention Screw-retained, with 3 or more splinted implants Screw-retained, with 3 or more splinted implants
Maxillomandibular Relationship -
Mesio-Distal Space Anatomic space corresponding to the missing teeth +/- 1 mm
Inter-Arch Distance > 8 mm
Bruxism Absent
Esthetic Risk Medium
Provisional Implant-Supported Prosthesis - -
Interim Prosthesis during Healing - -
Occlusion/Articulation Irregular with no need for correction
Occlusal Scheme/Issues -

Surgical SAC Modifiers

Periodontal Status History of periodontitis or genetic predisposition

Prosthodontic SAC Modifiers

Soft Tissue Contour and Volume Significantly deficient

General SAC Modifiers

Oral Hygiene and Compliance Insufficient
Access Adequate
Craniofacial/Skeletal Growth Completed

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